› Forums › General Melanoma Community › Newly diagnosed. Do I need a sentinel lymph node biopsy?
- This topic has 21 replies, 5 voices, and was last updated 11 years, 8 months ago by
melalisa.
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- September 6, 2012 at 1:54 am
I had a mole removed a few weeks ago and got a call last week that I have early stage melanoma. The doctor says I just need a wide local excision, which is scheduled for two weeks from now.
Here is the diagnosis from the pathology report:
Malignant melanoma, superficial spreading type, clark's level III, maximum extent of penetration 0.89mm, host response intense and focally lichenoid, no associated ulceration, rare mitotic figure.
I had a mole removed a few weeks ago and got a call last week that I have early stage melanoma. The doctor says I just need a wide local excision, which is scheduled for two weeks from now.
Here is the diagnosis from the pathology report:
Malignant melanoma, superficial spreading type, clark's level III, maximum extent of penetration 0.89mm, host response intense and focally lichenoid, no associated ulceration, rare mitotic figure.
Microscopic description: This is an atypical pigmented neoplasm with an irregular spread of nevomelanocytes, nests of different size and shape, at the dermoepidermal junction with focal invasion into the dermis. Individual cells are pleomorphic with a tendency to have loose cohesiveness in nests and for nests to coalesce. There is also single cell migration of cells into the prickle cell layer which consistently is present at the interface. This lesion yields a trailing effect on both lateral margins. There is little tendency to maturation as atypical cells extend into the dermis. The dpeth of penetration is measured at 0.89mm. The host response is focally lichenoid and intense. I do not see any ulceration of the surface. A rare mitotic figure is noted within the dermal nest.
From what I am finding online it appears I would be stage 1a or 1b. How would I know whether I should push for the sentinel node biopsy?
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- September 6, 2012 at 2:33 am
It's your decision. Most institutions use 1mm as the cutoff for the SNB unless you have other high risk factors. (You don't). Staging charts use 1mm for prognosis differentiation which is why that number makes the most sense to me. However, some institutions use .76mm. I had a .88mm lesion removed 11 years ago with very similar characteristics to yours. I didn't have the SNB. Still here 11 years later. Still stage IB. I don't regret not having it. This is me. You need to decide what works for YOU! Do your research and make a decision and don't look back. People who had the SNB tend to recommend it. People who don't …. don't. Technically, I'd say you don't need it. But emotionally, you need to decide that for yourself. There is no right or wrong answer – just the one you can live with.
Best wishes,
Janner
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- September 6, 2012 at 2:33 am
It's your decision. Most institutions use 1mm as the cutoff for the SNB unless you have other high risk factors. (You don't). Staging charts use 1mm for prognosis differentiation which is why that number makes the most sense to me. However, some institutions use .76mm. I had a .88mm lesion removed 11 years ago with very similar characteristics to yours. I didn't have the SNB. Still here 11 years later. Still stage IB. I don't regret not having it. This is me. You need to decide what works for YOU! Do your research and make a decision and don't look back. People who had the SNB tend to recommend it. People who don't …. don't. Technically, I'd say you don't need it. But emotionally, you need to decide that for yourself. There is no right or wrong answer – just the one you can live with.
Best wishes,
Janner
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- September 6, 2012 at 2:33 am
It's your decision. Most institutions use 1mm as the cutoff for the SNB unless you have other high risk factors. (You don't). Staging charts use 1mm for prognosis differentiation which is why that number makes the most sense to me. However, some institutions use .76mm. I had a .88mm lesion removed 11 years ago with very similar characteristics to yours. I didn't have the SNB. Still here 11 years later. Still stage IB. I don't regret not having it. This is me. You need to decide what works for YOU! Do your research and make a decision and don't look back. People who had the SNB tend to recommend it. People who don't …. don't. Technically, I'd say you don't need it. But emotionally, you need to decide that for yourself. There is no right or wrong answer – just the one you can live with.
Best wishes,
Janner
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- September 6, 2012 at 2:59 am
Listen to Jan – do what works for YOU.
Having said that, we all come at this with a different perspective. My melanoma was very similar to yours, .8, mitotic rate of less than 1, none of the "bad" risk factors such as ulceration or regression. SNB wasn't even in my vocabulary back then nor was it brought up to me. I was in the VERY SMALL minority that had it come back and now I'm stage IIIC but still going strong nearly 11 years later. If I had known of the SNB back then I know I would have wanted one as I didn't want to regret not having done more. The chances of yours recurring are terribly small and the SNB is not without it's own potential problems so you have to weigh the pros and cons of each, that very tiny possibility of recurrence against perhaps wishing it had been done further down the road.
Remember that this bulletin board is very lopsided in that many of us who weren't so lucky lurk here while the VAST majority of stage 1 people tend to get back to their lives and are out enjoying life. Remember that! Good luck to you. It is great that this was caught so thin. Let us know what you decide.
DebbieH, stage IIIC, NED nearly 11 years after interferon
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- September 6, 2012 at 2:59 am
Listen to Jan – do what works for YOU.
Having said that, we all come at this with a different perspective. My melanoma was very similar to yours, .8, mitotic rate of less than 1, none of the "bad" risk factors such as ulceration or regression. SNB wasn't even in my vocabulary back then nor was it brought up to me. I was in the VERY SMALL minority that had it come back and now I'm stage IIIC but still going strong nearly 11 years later. If I had known of the SNB back then I know I would have wanted one as I didn't want to regret not having done more. The chances of yours recurring are terribly small and the SNB is not without it's own potential problems so you have to weigh the pros and cons of each, that very tiny possibility of recurrence against perhaps wishing it had been done further down the road.
Remember that this bulletin board is very lopsided in that many of us who weren't so lucky lurk here while the VAST majority of stage 1 people tend to get back to their lives and are out enjoying life. Remember that! Good luck to you. It is great that this was caught so thin. Let us know what you decide.
DebbieH, stage IIIC, NED nearly 11 years after interferon
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- September 6, 2012 at 2:59 am
Listen to Jan – do what works for YOU.
Having said that, we all come at this with a different perspective. My melanoma was very similar to yours, .8, mitotic rate of less than 1, none of the "bad" risk factors such as ulceration or regression. SNB wasn't even in my vocabulary back then nor was it brought up to me. I was in the VERY SMALL minority that had it come back and now I'm stage IIIC but still going strong nearly 11 years later. If I had known of the SNB back then I know I would have wanted one as I didn't want to regret not having done more. The chances of yours recurring are terribly small and the SNB is not without it's own potential problems so you have to weigh the pros and cons of each, that very tiny possibility of recurrence against perhaps wishing it had been done further down the road.
Remember that this bulletin board is very lopsided in that many of us who weren't so lucky lurk here while the VAST majority of stage 1 people tend to get back to their lives and are out enjoying life. Remember that! Good luck to you. It is great that this was caught so thin. Let us know what you decide.
DebbieH, stage IIIC, NED nearly 11 years after interferon
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- September 7, 2012 at 4:07 am
Melalisa — It looks like you might have been treated at a Dermatologist's office? If so, I would suggest a second opinion on your whole situation, including the pathology, at a melanoma center located at a major medical center. Dermatolgists tend not to recommend the SNB because they don't do them. If you haven't seen a real melanoma specialist — an oncological surgeon who specializes in melanoma — I think you should make an appointment. Just my opinion.
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- September 7, 2012 at 4:07 am
Melalisa — It looks like you might have been treated at a Dermatologist's office? If so, I would suggest a second opinion on your whole situation, including the pathology, at a melanoma center located at a major medical center. Dermatolgists tend not to recommend the SNB because they don't do them. If you haven't seen a real melanoma specialist — an oncological surgeon who specializes in melanoma — I think you should make an appointment. Just my opinion.
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- September 7, 2012 at 4:07 am
Melalisa — It looks like you might have been treated at a Dermatologist's office? If so, I would suggest a second opinion on your whole situation, including the pathology, at a melanoma center located at a major medical center. Dermatolgists tend not to recommend the SNB because they don't do them. If you haven't seen a real melanoma specialist — an oncological surgeon who specializes in melanoma — I think you should make an appointment. Just my opinion.
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- September 7, 2012 at 11:45 pm
Thank you all for the advice. I found out today there is a melanoma center at the James Cancer Hospital (part of the Ohio State University Medical Center) near me. After talking to them and my family, I have decided to go ahead with the WLE at the derm and then go see an oncologist at the melanoma center afterwards and have everything forwarded to them to see if they recommend any further tests. I have already made the appointment for two weeks after my WLE. Even if they tell me I don't need any further testing, I will at least have gotten a second opinion from a very reputable hospital and that should give me peace of mind.
I do have one more question though. Do you think my dermatologist will be upset for going to get a second opinion? I have never done that before and I'm not really sure how they feel about that.
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- September 7, 2012 at 11:45 pm
Thank you all for the advice. I found out today there is a melanoma center at the James Cancer Hospital (part of the Ohio State University Medical Center) near me. After talking to them and my family, I have decided to go ahead with the WLE at the derm and then go see an oncologist at the melanoma center afterwards and have everything forwarded to them to see if they recommend any further tests. I have already made the appointment for two weeks after my WLE. Even if they tell me I don't need any further testing, I will at least have gotten a second opinion from a very reputable hospital and that should give me peace of mind.
I do have one more question though. Do you think my dermatologist will be upset for going to get a second opinion? I have never done that before and I'm not really sure how they feel about that.
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- September 7, 2012 at 11:45 pm
Thank you all for the advice. I found out today there is a melanoma center at the James Cancer Hospital (part of the Ohio State University Medical Center) near me. After talking to them and my family, I have decided to go ahead with the WLE at the derm and then go see an oncologist at the melanoma center afterwards and have everything forwarded to them to see if they recommend any further tests. I have already made the appointment for two weeks after my WLE. Even if they tell me I don't need any further testing, I will at least have gotten a second opinion from a very reputable hospital and that should give me peace of mind.
I do have one more question though. Do you think my dermatologist will be upset for going to get a second opinion? I have never done that before and I'm not really sure how they feel about that.
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- September 8, 2012 at 2:42 am
First of all, no worthwhile Dr. will be upset about your going for a second opinion, and even if he/she was upset, you have to do what's best for you. When my husband was diagnosed in 2007, no one ever mentioned SNB to us. Three years later, it reappeared in the sentinel node under the affected arm. Would it have shown up three years before, we don't know, but I wish we would have had the option at the time.
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- September 8, 2012 at 2:42 am
First of all, no worthwhile Dr. will be upset about your going for a second opinion, and even if he/she was upset, you have to do what's best for you. When my husband was diagnosed in 2007, no one ever mentioned SNB to us. Three years later, it reappeared in the sentinel node under the affected arm. Would it have shown up three years before, we don't know, but I wish we would have had the option at the time.
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- September 8, 2012 at 2:42 am
First of all, no worthwhile Dr. will be upset about your going for a second opinion, and even if he/she was upset, you have to do what's best for you. When my husband was diagnosed in 2007, no one ever mentioned SNB to us. Three years later, it reappeared in the sentinel node under the affected arm. Would it have shown up three years before, we don't know, but I wish we would have had the option at the time.
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- September 8, 2012 at 3:41 am
Melalisa — You are making a good move by going to the center. You'll realize immediately that your team knows melanoma inside and out. It will be interesting to hear what they say. Just tell the derm that the melanoma center was recommended to you and you decided on a second opinion. Good luck and make sure you stop back to let us know how you are doing.
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- September 8, 2012 at 3:41 am
Melalisa — You are making a good move by going to the center. You'll realize immediately that your team knows melanoma inside and out. It will be interesting to hear what they say. Just tell the derm that the melanoma center was recommended to you and you decided on a second opinion. Good luck and make sure you stop back to let us know how you are doing.
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- September 8, 2012 at 3:41 am
Melalisa — You are making a good move by going to the center. You'll realize immediately that your team knows melanoma inside and out. It will be interesting to hear what they say. Just tell the derm that the melanoma center was recommended to you and you decided on a second opinion. Good luck and make sure you stop back to let us know how you are doing.
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Tagged: cutaneous melanoma
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